You are a first day intern (literally, for many of you), the cardiac room is overflowing with patients and you are asked to set up for endotracheal intubation on a patient with declining mental status.  You haven’t intubated since your anesthesia rotation and you’re worried you may experience some difficulty with the procedure.  What can you do to delay desaturation in the event that you need more time to intubate?

Apneic oxygenation, occurs after the period of preoxygenation and refers to providing NC at a flow of about 5L/min during the period in which the patient is sedated and paralyzed or apneic during the periintubation period.  Multiple studies comparing apneic oxygenation groups to controls support that the apneic oxygenation group had a significant prolongation of time spent at a SpO2 greater than or equal to 95%.  One randomized trial of obese patients going in for elective surgery showed that apneic oxygenation provided 5.29 minutes above or at 95% SpO2 versus 3.49 minutes in the control group.  Another study of anesthesia patients cites that apneic oxygenation provided 6 minutes at SpO2 greater than or equal to 95% vs 3.65 minutes in the control group.  That may just be the extra time you need to properly complete your procedure!